Metabolic syndrome in adult long-term survivors of childhood cancer.

METABOLIC SYNDROME:

1. Waist circumference (high in males when >102cm and in females when >88cm);

2. Waist/Hip ratio (high when >0.9);

3. Fasting plasma glucose (high when >=5.6 mmol/l));

4. Triglycerides (high when >=1.7 mmol/l);

5. HDL-cholesterol (high in males when <1.03 and in females when <1.3);

6. Blood pressure (high when >= 130/85).



CARDIOVASCULAR RISK FACTORS:

Imaging studies:

1. Ultrasound of carotids for measurement of intima media thickness;

2. Pulse wave velocity;

3. Ultrasound of abdominal fat (subcutaneous and preperitoneal).

Laboratory investigations:

1. Uric acid;

2. Cystatin C;

3. Lipidspectrum (total cholesterol, LDL, VLDL, HDL, free fatty acids, triglycerides, apolipoprotein A and B);

4. Thrombotic factors (Antithrombine III, Protein C and S, homocysteine, Plasminogen activator inhibitor-1 (PAI1), routine clotting parameters);

5. Pro-inflammatory markers (TNF-α, IL-6, (high sensitivity)-CRP);

6. Endocrine tests (free T4, TSH, cortisole rhythm (from saliva), IGF-1, IGF-BP-3 and BP-1, ACTH, and routine fertility screening (In females: AMH, Inhibin A en B, DHEA. If not on contraceptives: FSH, LH, oestradiol, progesterone, SHBG. In males: Inhibin B, AMH, testosterone, LH, FSH, SHBG);

7. Insulin;

8. Biomarkers for adiposity (leptin, adiponectin, adipokine);

9. Molecular analyses of genetic aberrations associated with risk factors for elevated metabolic syndrome, i.e. (P207L, D9N mutations in the lipoprotein lipase gene) peroxisome proliferative-activated receptor gamma2 (PPARγ2, aldose reductase, ABCG5 and ABCG8, SUR1, Kir 6-2 gene aberrations, Lipin1 SNPs, AMH SNPs;

10. ALAT, ASAT, gamma-GT;

11. Urine analysis: Microalbuminuria and albumin/creatinin ratio.

ADRENAL FUNCTION:

Cortisol and precursos (testosterone, DHEA, DHEAs, 17(OH)progesteron, adion) levels during Synacthen-test (ACTH stimulation test): At baseline, 30 minutes later and 60 minutes later.



PHYSICAL ACITVITY:

The five categories of health-related fitness will be investigated using a series of standardised and validated tests:

Category 1: Cardiopulmonary fitness:

The six-minute walk test, a sub-maximal test, will be used to assess cardiopulmonary fitness;

Category 2: Muscle strength and Category 4: Muscle endurance:

These categories will be measured using the following tests: Hand grip, push-ups, dynamic sit-up, back extension and standing high jump;

Category 3: Flexibility:

The following tests will be used to assess flexibility: Reaching upwards, side bending, sit & reach;

Category 5: Body composition.